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Good Positive and Negative Likelihood Ratios

Good Positive Likelihood Ratio

Helicobactor pylori: Likelihood Ratios

Introduction: From UpToDate (http://www.utdol.com/online/content/topic.do?topicKey=acidpep/4732 ):

The ACG guidelines made the following conclusions:

  • Testing for H. pylori should be performed only if the clinician plans to offer treatment for positive results.
  • * Testing is indicated in patients with active peptic ulcer disease, a past history of documented peptic ulcer or gastric MALT lymphoma.

  • The test-and-treat strategy for H. pylori (ie, test and treat if positive) is a proven management strategy for patients with uninvestigated dyspepsia who are under the age of 55 years and have no "alarm features" (bleeding, anemia, early satiety, unexplained weight loss, progressive dysphagia, odynophagia, recurrent vomiting, family history of GI cancer, previous esophagogastric malignancy).
  • * Deciding which test to use in which situation relies heavily upon whether a patient requires evaluation with upper endoscopy and an understanding of the strengths, weaknesses, and costs of the individual test.

    [Edit Diagnosis] [Merge dx] [Add prevalence]

    Tags: Gastrointestinal Problem Infection Tag this Diagnosis.

    The likelihood ratios of findings for Helicobactor pylori are listed below. See the left navigation bar to change the display.

    Good Positive and Negative Likelihood Ratios

    Finding +LR-LR Comments, Study
    Antral biopsy urease test Edit 180.1

    [sens/spec is per UpToDate]

    One reason for lack of specificity: If specifmen contains less common non-pylori gastric helicobacters, which give only weakly positive results in the biopsy urease test. Positive identification of these bacteria requires visualization of the characteristic long, tight spirals in histologic sections.

  • Adapted from Harrison's Online Chapter 144: Helicobactor pylori infections
  • Study: Am J Gastroenterol. 2007 Aug;102(8):1808-25. PMID 17608775

    Urea breath test Edit 11.60.1

    in patients with an UGIB.

    Study: Am J Gastroenterol. 2006 Apr;101(4):848-63. PMID 16494583

    Stool antigen test Edit 2.90.2

    in patients with UGIB

    Study: Am J Gastroenterol. 2006 Apr;101(4):848-63. PMID 16494583

    Serology Edit 2.80.2

    in patients with UGIB

    Study: Am J Gastroenterol. 2006 Apr;101(4):848-63. PMID 16494583

    Biopsy histology Edit 70.3

    in patients with UGIB.

    Study: Am J Gastroenterol. 2006 Apr;101(4):848-63. PMID 16494583

    Rapid urease test Edit 9.60.4

    in patients with UGIB.

    Study: Am J Gastroenterol. 2006 Apr;101(4):848-63. PMID 16494583

    Good Positive Likelihood Ratio

    Finding +LR-LR Comments, Study
    Biopsy culture Edit 22.50.6

    In addition to diagnosis, biopsy culture allows for determination of antibiotic sensitivity

    Study: Am J Gastroenterol. 2006 Apr;101(4):848-63. PMID 16494583